Haryana

Karnal

CC/662/2021

Smt. Kamla Devi - Complainant(s)

Versus

The New India Assurance Company Limited - Opp.Party(s)

S.S. Moonak

30 Nov 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                        Complaint No. 662 of 2021

                                                        Date of instt.30.11.2021

                                                        Date of Decision: 30.11.2023

 

Smt.Kamla Devi aged 65 years wife of late Ravi Dutt son of late Shri Indraj, resident of VPO Munak, District Karnal (Aadhar No.8545 2935 6453)

 

                                               …….Complainant.

                                              Versus

 

The New India Assurance Company Limited, Opposite Bus Stand, Karnal, through its Divisional Manager.

 

                                                                      …..Opposite party.

 

Complaint Under Section 35 of the Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Suman Singh……Member

          

 Argued by: Shri S.S.Moonak, counsel for the complainant.

                    Shri Manjul Mishra, counsel for the OP.

 

                    (Jaswant Singh President)

ORDER:   

                

                   The complainant has filed the present complaint Under Section 35 of Consumer Protection Act, 2019 against the opposite party (hereinafter referred to as ‘OP’) on the averments that husband of complainant namely Ravi Dutt (since deceased) was registered owner of motorcycle bearing temporary No.HR-2021/TR/5365 (T) now (RC No.HR40H-6267), which was got insured from the OP from 24.03.2021 to 23.03.2026. He also paid extra premium for covering PA claim of Rs.15,00,000/-. The husband of the complainant died in a road side accident on 25.04.2021 in village Munak, District Karnal. The matter was reported to the local police and a case was registered with the police of P.S. Munak, District Karnal, and DDr was recorded. After the death of Ravi Dutt, the complainant alongwith her son Anil Kumar approached the OP and submitted claim form and all other relevant documents and later on through registered post on 08.06.2021, which were duly acknowledged. Due to non-settlement of the personal accident claim, the complainant has suffered great mental pain, agony as well as financial loss. Complainant also served a legal notice to the OP trough registered post but the OP has not given any response in this regard. In this way there is deficiency in service and unfair trade practice on the part of the OP. Hence this complaint.

2.             On notice, OP appeared and filed its written version raising preliminary objections with regard to maintainability; concealment of true and material facts; deficiency of service, etc. On merits, it is pleaded that the OP appointed Mr.Gurmeet Singh, investigator to investigate the matter and the said investigator on behalf of company requested the complainant to provide necessary documents to process the claim as per the terms and conditions of the policy, but the complainant has not provided the same. The terms and conditions of the policy were explained to the policy holder at the time of proposing policy and the same was served to the policy holder alongwith policy schedule. The policy is contractual in nature and the claims arising therein are subject to the terms and conditions forming part of the policy. The policy holder has accepted the policy agreeing and being fully aware of such terms and conditions. It is correct that the complainant has served legal notice by her advocate on 14.08.2021 to the OP and reply dated 15.09.2021 on behalf of the OP was given to complainant and asked her to provide necessary documents for settlement of her claim. There is no deficiency in service on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copies of bill Ex.C1 and Ex.C2, copy of insurance policy Ex.C3, copy of driving licence Ex.C4, copy of death certificate Ex.C5, copy of DDR Ex.C6, copy of application for settlement of claim Ex.C7, copy of postal receipt Ex.C8,  copy of legal notice Ex.C9, copy of postal receipt Ex.C10 and copy of acknowledgement Ex.C11, and closed the evidence on 05.06.2023 by suffering separate statement.

5.             On the other hand, learned counsel for the OP has tendered into evidence affidavit of K.K.Sachdeva, Divisional Manager Ex.RW1/A, copy of letters dated 31.08.2021 Ex.OP1, copy of letter dated 15.09.2021 Ex.OP2, copy of letter dated 23.09.2021 Ex.OP3, copy of letter dated 15.09.2021 Ex.OP4, copy of reply of legal notice Ex.OP5, copy of investigation report Ex.OP6, coy of letter dated 17.06.2021 Ex.OP7, copy of statement of Anil Kumar Ex.OP8, copy of statement of Rajbir Ex.OP9 and closed the evidence on 28.07.2022 by suffering separate statement.

6.             We have heard the learned counsel of the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that Ravi Dutt (husband of the complainant) during his life time had obtained a Personal Accident Policy from the OPs. On 25.04.2021, the complainant has died in a road side accident. DDR was got lodged. Complainant informed the OPs about the death of her husband and lodged the death claim with the OPs and submitted all the required documents and also requested the OPs to release the benefits under the policy in question but the officials of the OPs did not pay any heed to the request of the complainants and repudiated the claim of complainant, vide letter dated 15.09.2021 on the false and frivolous ground and lastly prayed for allowing the complaint.

8.             Per contra, learned counsel for the OP, while reiterating the contents of written version, has vehemently argued that despite repeated requests, the complainant did not supply the requisite documents, therefore, the claim of the complainant has been closed vide letter dated 15.09.2021 Ex.OP2 and lastly prayed for dismissal of the complaint.

9.             We have duly considered the rival contentions of the parties.

10.           Admittedly, life assured purchased the personal accident policy from the OP for the sum assured of Rs.15 lakhs. It is also admitted that life assured had died.

11.           The claim of the complainant has been closed by the OP, vide repudiation letter Ex.OP2 dated 15.09.2021 on the ground, which is reproduced as under:-

”We are closing your claim file on account of following reason: Kindly refer to the letter dated 17.06.2021 and 31.08.2021, the claim formalities have still not been provided by you. Hence, closing the claim as “No Claim”.

 

12.           The claim of the complainant has been closed by the OPs on the ground of not providing the requisite documents. The onus to prove its version was relied upon the OP. To prove its version, OP has relied upon the letter Ex.OP1 dated 31.08.2021, letter dated 23.09.2021 Ex.OP3, reply to the legal notice Ex.OP5, whereby, the OP has requested the complainant to complete the claim formalities and to supply the requisite documents. In the report of investigator, the investigator has specifically mentioned that alleged accident occurred on 25.04.2021 as per GDR and family statement but no proof of accident has been given. No information to the police. As per the death certificate, place of death is mentioned as Munak, District Karnal, which is his residential address but in all accidental cases, place of death is mentioned as Hospital name or accidental site. As per photographs of motorcycle, there was no loss to the motorcycle. On the other hand, in order to prove her version, the complainant has relied upon copies of bills Ex.C1 & Ex.C2, copy of insurance policy Ex.C3, copy of DL Ex.C4, copy of death certificate Ex.C5, and copy of GDR Ex.C6. The complainant has not placed on file any other documents which were demanded by the OP. Furthermore, from all these documents which has been placed on file by the complainant no where it has been proved that the husband of the complainant has died in a road side accident. However, without supplying the requisite documents which were demanded by the OP, the claim of the complainant cannot be settled.

13.           Furthermore, if the complainant had submitted the claim with the OP and supplied the required documents, they would have placed the copies of said documents on the file. Moreover, the complainant has also failed to disclose date and month for submission of requisite documents with the OP. Thus, we are of the considered view that complainant has not submitted the requisite document with the OP.  Hence, in view of the above, the present complaint is premature and not maintainable at this stage.

14.           In view of the above observation, the present complaint is disposed of with the liberty to the complainant to submit the requisite documents as required by the OP and on receipt of the same, OP is hereby directed to settle the claim of the complainant within 60 days from the date of receipt of copy of the order, as per the terms and conditions of the policy. No order as to costs. This order shall be complied with accordingly. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Dated: 30.11.2023.                                                                   

                                                                 President,

                                                    District Consumer Disputes

                                                    Redressal Commission, Karnal.

 

(Vineet Kaushik)        (Dr. Suman Singh)

                     Member                        Member